Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings.

OBJECTIVES

The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies.

METHODS

This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution.

RESULTS

Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50%) were due to infections, one (17%) to organizing pneumonia, and two (33%) remained of undetermined origin. Among the multiple lesions, 14 (78%) were due to infection, three to post-transplant lymphoproliferative disorder (17%), and one to bronchogenic carcinoma (5%). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33%) were due to malignancy: three post-transplant lymphoproliferative disorders (25%), and one bronchogenic carcinoma (8%). Among five cavitary nodules four (80%) were due to aspergillosis.

CONCLUSION

Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered.

KEY POINTS

Pulmonary nodules and masses are frequent in lung transplant recipients. Infection is the most frequent aetiology of solitary and multiple pulmonary nodules. Differential diagnosis includes post-transplant lymphoproliferative disorder, bronchogenic carcinoma, and organizing pneumonia. Clinical and CT findings are often non-specific. CT findings may be suggestive of some aetiologies that justify a biopsy.